Kenya

Our Impact

Kenya’s path to Universal Health Coverage (UHC) accelerated in 2018 when President Uhuru Kenyatta declared UHC and health one of the ‘four pillars’ of his presidency.

In January 2018 iDSI begun close engagement with the Government of Kenya on the development of the Health Benefits Package and on an economic evaluation with two HIV programmes – the National AIDS and STI Control Program (NASCOP) and the National AIDS Control Council (NACC).

Key impacts:

Appointment of a technical working group bringing together local partners

Scoping of a research topic through multiple in-country consultations

Capacity building workshop on costing methods held in Nairobi

Finalisation of a research protocol that employs robust methods for the evaluation

Organisation of a data collection process

Kenya has made important strides in improving life expectancy and reducing maternal and child mortality over the last decades. However, important gaps remain, especially as health inequalities between regions and socio-economic groups widen.

Kenya’s HIV epidemic has declined significantly in the last two decades, making Kenya one of the success stories of Africa’s fight against HIV. However, the number of people living with HIV on treatment has grown considerably, and there is a need for new approaches to scaling up treatment.

Supporting the scale up of anti-retroviral therapy

In 2016, the Ministry of Health released an update to ART delivery in Kenya, which contained an important shift to differentiated care (DC) pathways – a patient-centred approach aiming to provide services based on individual needs.

With increasing numbers of people living with HIV on treatment and scarce resources to support the health system, DC offers an opportunity to use the limited resources more efficiently. However, DC requires a shift in client flow within facilities, upfront investments and retraining. Across the globe there are reports that DC is not always correctly implemented, often at the expense of people living with HIV.

Four pathways were developed in Kenya for patients in 2016: new patients (on ART for less than 12 months) presenting well or with advanced disease; patients on ART for more than 12 months, stable or unstable.

Impact

iDSI is working with NASCOP, NACC and the Global Fund to Fight AIDS, Tuberculosis and Malaria – initiatives that have supported providers in the implementation of the new DC guidelines through a quality improvement (QI) programme (DC+QI) – to evaluate the contribution of QI in support of DC implementation.

The evaluation will look at the effects of DC+QI along a wide range of outcomes: processes of care and programme efficiency; costs (using a time-driven activity based costing approach); and patient outcomes (including quality of life).

A technical working group has been appointed to support this work, with the aim to conduct the research collaboratively, with staff posted at NASCOP and NACC supporting the design, data collection, write-up and dissemination of the project.

Our aim is to train local staff from NASCOP and NACC on research design and economic evaluation methods; since inception this project has sparked renewed conversations on the need for costing to support programming and budgeting at the Kenyan Ministry of Health.

Regina Ombam, Deputy Director of HIV Financing at NACC and Chair of the Technical Working Group, said: “Our collaboration with iDSI to enhance the strategic impact of Kenya’s HIV response will increase our nations health and economic returns on investment in health; and help realise our aim of attaining Universal Health Coverage by 2022.”

Dr Kigen Bartilol, Head of NASCOP, said: “The project is another opportunity to support the expansion of HIV service delivery using a quality improvement approach in low and middle-income countries, with an overall goal of improved HIV treatment outcomes and customer satisfaction. The differentiated care costing stream will provide invaluable information for the HIV program to strategically align its interventions and service delivery through smart investments.”

This work is supported by the Department for International Development; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and iDSI.

A fair and accountable process for developing a Health Benefits Package

Prior to President Uhuru Kenyatta’s commitment to include Universal Health Coverage as one of the items of the ‘four pillars’ of his presidency, a fragmented system of compulsory and voluntary health insurance was in place.

Current plans in Kenya are to expand coverage of lifesaving health services to all Kenyans by 2022. A pilot scheme has been implemented in four counties across the country, with a goal to reach all 47 counties by 2022. The UHC Secretariat, a team formed within the Kenyan Ministry of Health, will provide technical input to support these plans.

A Health Benefits Package (HBP) Advisory Panel, comprised of experts in the Kenyan health sector, has been tasked to develop a HBP to support the pilot and roll-out nationwide, based on budget projections and best evidence in the country (on a range of issues, including cost, cost-effectiveness and clinical benefit). The panel has developed and is following a list of criteria to assess the inclusion and exclusion of services and drugs in the HBP.

Impact

iDSI has provided support to the UHC Secretariat and the HBP Advisory Panel on a variety of topics since February 2018.

iDSI provided input on initial plans, supported the launch of the HBP advisory panel in July 2018. In November 2018, a study tour to Thailand (including to the Health Intervention and Technology Appraisal Program) composed of delegates of the advisory panel, Ministry of Health and UHC Secretariat was also organised and supported by iDSI.